Former Nursing Home Administrator Sentenced to Federal Prison for Stealing Veterans Benefits

ATLANTA – Denise M. Bailey, the former administrator of an assisted living facility, has been sentenced to federal prison for misappropriating over $300,000 in veterans benefits that belonged to one of the facility’s residents.

“While working as a nursing home administrator, the defendant stole disability benefits from a Vietnam veteran who lived in the nursing home,” said U.S. Attorney John Horn. “This disabled veteran was entitled to every penny of his disability award after honorably serving our country, and needed the money to live comfortably in assisted living – yet Bailey spent the money for her own personal expenses.”

Special Agent in Charge Monty Stokes, U.S. Department of Veterans Affairs, Office of Inspector General said, “today’s sentencing is the result of a joint effort to investigate and prosecute a VA fiduciary who embezzled funds from a veteran who was not capable of managing his financial affairs. We will continue to vigorously investigate those whose actions corrupt the integrity of VA fiduciary programs intended to care for our nation’s venerable veterans.”

According to U.S. Attorney Horn, the charges and other information presented in court: Bailey was the administrator at Azalea Gardens, an assisted living facility located in Conyers, Georgia. One of the facility’s residents was a Vietnam veteran who needed long-term care after suffering a heart attack in 2006. In December 2010, the Department of Veterans Affairs appointed Bailey to be the fiduciary for the veteran. As his fiduciary, Bailey agreed to use any veterans benefits awarded to the veteran only for his benefit.

On July 7, 2011, the VA awarded the veteran retroactive disability benefits in the amount of $313,452.37, which was deposited in an account held in the name of the veteran with Bailey as administrator. Bailey drained the account within four days. After transferring the money from that account to the Azalea Gardens account, Bailey transferred the majority of it to herself, or accounts controlled by her, and used a portion to pay off family credit cards bills. During the later VA investigation, Bailey submitted fraudulent bills in an attempt to justify the payments, falsely claiming that the veteran owed money to Azalea Gardens for extraordinary services. Bailey had not informed the veteran or his family about the VA payment or the alleged bills for these services.

Bailey, 49, of Danielsville, Georgia, was sentenced by United States District Judge Thomas W. Thrash, Jr., to one year in prison and two years of supervised release. A decision will be made at a later date regarding the restitution amount still owed to Henderson’s family. On July 7, 2015, Bailey pleaded guilty to misappropriating veterans funds while acting as a fiduciary.

This case was investigated by Special Agents of the Department of Veterans Affairs, Office of Inspector General. Valuable assistance was also provided by the Conyers Police Department.

The Star reported that Ontario’s new associate minister of long term care, Dipika Damerla, says she is “saddened and troubled” by photographs of gaping, infected bedsores published in a Star investigation. France Gelinas, New Democrat health critic at Queen’s Park, said the bedsore pictures of 88-year-old Fatemeh Hajimoradi and 93-year-old Dorothy Benson are a sobering reminder that there’s no strict oversight of nursing homes.

“This is simply not acceptable,” Dipika Damerla said in a written statement. “We must do more to ensure that incidents such as these do not occur.”

The Star investigation told the story of Dorothy Benson, who died in hospital after developing severe pressure ulcers in The Waterford, her Oakville nursing home. Benson’s son, Sheldon, complained to the ministry and later gave the Star photographs showing the terrible trauma the pressure ulcers inflicted on her leg and foot.

In that case, the inspector came down hard on the home and cited it for numerous violations. The report initially said the home’s “inaction contributed to the resident’s death while in hospital.” The ministry later deleted that line with black ink and replaced it with a handwritten note saying the home didn’t contribute to the death, but “jeopardized the well-being of the resident.”

He said the lack of action shows that it’s “open season on seniors.” Halton Regional Police said the coroner’s office told them there was no reason to investigate and the coroner later refused Sheldon’s call for an inquest. Seniors’ advocate Jane Meadus said the government’s first step should be to focus on improving inspectors’ investigation skills. “It’s hit and miss, spotty at best,” said Meadus, a lawyer with the Advocacy Centre for the Elderly.

Sen. Dick Durbin (D-IL) recently joined Sen. Al Franken (D-MN) and a coalition of other senators in calling on the Centers for Medicare and Medicaid Services (CMS) to prohibit the use of unfair pre-dispute arbitration clauses in contracts with long-term care facilities, such as nursing homes.

“The decision to admit yourself or a loved one to a long-term care facility can be difficult,” the senators wrote in a letter to CMS acting Administrator Andy Slavitt. “All too often, only after a resident has suffered an injury or death, do families truly understand the impact of the arbitration agreement they have already signed … we strongly urge CMS to fully protect residents and their families by banning pre-dispute arbitration clauses in long-term care facility contracts.”

Such clauses make it more difficult for victims to seek fair redress after they’ve been wronged. At the moment, CMS is taking steps to reform its requirements for long-term care facilities participating in Medicare and Medicaid.

McKnight’s reported that HSR: Health Services Research has found that one of the leading indicators of hospital readmission in nursing homes is the prevalence of pressure ulcers. HSR’s research found that quality measures like pressure ulcer rates could affect hospital readmission rates regardless of county. Nursing homes with long term residents with pressure sores were more likely to readmit residents to hospitals. The acuity of the residents also affected whether the facility had higher readmit rates. Other quality measures weren’t found to be good predictors of readmission. Overall, HSR found that the majority of reasons patients are readmitted to the hospital are for reasons beyond their control, including nursing home care. Pressure ulcer prevalence was found to be a good predictor of readmission. Readmission rates will affect skilled nursing facilities’ payments in 2018, according to a law passed last year.

McKnight’s reported on the letter, signed by 34 Democrats including lead signer Sen. Al Franken (D-MN), on recent efforts by CMS to improve resident awareness of arbitration clauses which ultimately complicate any future disputes and fail to improve safety. Language aimed at improving resident awareness of the clauses was included in July’s proposed rule for long-term care facilities.

Arbitration clauses inserted into nursing home admission contracts do not adequately protect residents’ rights, and should be outright banned, senators urged the Centers for Medicare & Medicaid Services in a letter this week.

The senators recommended CMS prohibit the use of binding pre-dispute arbitration clauses in nursing home contracts in order to “ensure that residents and their families are not deprived of their rights.”

“All too often, only after a resident has suffered an injury or death, do families truly understand the impact of the arbitration agreement they have already signed,” the letter states.

The letter stresses that nursing home residents and their families should only enter into arbitration agreements after an incident has occurred, allowing them to consider all of their legal rights.

The Centers for Medicare and Medicaid Services (CMS) published the August 2015 Special Focus Facility List (SFF August 2015). The CMS visits nursing homes to assure that they are administering the quality of care that Medicare and Medicaid require. CMS will identify any deficiencies in the quality of care being provided, as well as if the facility is meeting safety requirements.

Once the CMS’ “survey” teams gather their data from the facilities, this is submitted to The Special Focus Facility List. This list includes all facilities with a history of care problems and/or poor surveys, and is updated monthly by the CMS. Every special focus facility must be visited by a CMS survey team at least twice a year.

Any facility on the list will have a yellow triangle with an exclamation point next to its name on Medicare’s Nursing Home Compare website. Additionally, you can use the website to see other ratings for the facility, including health inspections, staffing and quality measures. At the moment, there are only a few nursing homes in South Carolina on the most current Special Focus Facility List. These facilities include:

County owned and operated nursing home has host of problems including financial losses, wandering residents, and political red tape. After a proposal to privatize the Albany County Residential Health Care Facility failed, a measure to “create a local development corporation to take over operations”. However, some politicians who opposed the measure, like Rich Mendick, asked, “So if they are getting money from the county, and they are using county employees, what’s changed?” The issue is still heavily under debate as to who will own the facility, what this will do in terms of financial management, and whether the corporation will be a provider of health care. During the time it takes to make these decisions, residents and employees of the home are unsure what will happen to them and their home. See article in the Times Union.

WJBD Radio reported the arrest of Amy Heiman who is accused of covering the face of a 95-year-old disabled patient at Fireside House in Centralia with pillows. Heiman was working as a Certified Nurse Assistant at the time. She was charged with aggravated battery to a senior citizen.

Centralia Police say Heiman had told another employee about what she had done because the disabled woman allegedly would not be quiet. That employee reported the incident to the administration who started an internal investigation and called police.

The Register Star reported that Claire Wieland, an employee of Livingston Hills Nursing and Rehabilitation Center, was arrested in White Plains for allegedly stealing more than $6,000 from a residents between in 2013 and 2014 by cashing checks from a trust fund with forged signatures of residents. She was charged with 24 counts of second-degree criminal possession of a forged instrument, a class D felony, two counts of fourth-degree grand larceny, a class E felony, and seven counts of petit larceny, a class A misdemeanor.

Weiland worked as a receptionist at the nursing home during the time of the alleged crimes and was in charge of withdrawing funds from an account maintained by an outside bank holding resident’s commingled funds, according to Schneiderman’s office. The indictment alleges on multiple occasions between April 2013 and February 2014, Weiland forged signatures of residents to endorse 24 checks, then cashed them and kept the money.

Yesterday, U.S. Sen. Al Franken (D-Minn.) led a broad coalition of 34 Senators in calling on the Centers for Medicare and Medicaid Services (CMS) to outlaw the use of unfair pre-dispute arbitration clauses in contracts with long-term care facilities like nursing homes. These types of clauses make it nearly impossible for victims to seek fair redress after they’ve been wronged.

Right now, CMS is taking steps to reform its requirements of long-term care facilities participating in Medicare and Medicaid programs. And while the agency has proposed new protections for residents who live in those facilities, and for their families as well, it has not adequately addressed the problem of binding, pre-dispute arbitration clauses—where consumers waive their legal rights before any harm has actually occurred.

“The decision to admit yourself or a loved one to a long-term care facility can be difficult,” wrote the lawmakers in a letter to CMS Acting Administrator Andy Slavitt. “All too often, only after a resident has suffered an injury or death, do families truly understand the impact of the arbitration agreement they have already signed…we strongly urge CMS to fully protect residents and their families by banning pre-dispute arbitration clauses in long-term care facility contracts.”

As a strong advocate for consumers and workers in cases of forced arbitration, Sen. Franken has long been fighting to ban these types of clauses in contracts. Earlier this year, he led a group of more than 50 members of Congress in calling on the nation’s top consumer agency to eliminate forced arbitration agreements in consumer financial contracts for credit cards, private student loans, and payday loans. He also has legislation, called theArbitration Fairness Act, that he introduced to restore the rights of consumers, workers, and small businesses to seek justice through the courts. Sen. Franken has also previously introduced measures to ban mandatory arbitration clauses in cell phone and mobile data service contracts and in college enrollment contracts.